Abstract
To investigate the role of lactulose in the treatment of cirrhotic patients with subclinical hepatic encephalopathy (SHE), 40 cirrhotic patients, 33 males and 7 females, were included in the study. The diagnosis of SHE was made by quantitative psychometric tests including the number connection test (NCT), figure connection test (FCT) parts A and B, and two performance subtests of Wechsler adult intelligence scale, ie, picture completion (PC) and block design (BD) tests. SHE was diagnosed in 26 (65%) of 40 patients. Of these 26 patients, 14 patients were randomized to treatment group (lactulose 30–60 ml/day for three months, SHE-L) and 12 patients to no treatment group (no lactulose, SHE-NL). Psychometric tests were repeated in all patients in both groups and in six patients with no SHE (group NSHE, N = 14) after three months. The mean scores and number of the abnormal psychometric tests at entry were significantly higher in patients in groups SHE-L and SHE-NL than in patients in group NSHE; however, there was no significant difference between SHE-L and SHE-NL. The mean number of the abnormal psychometric tests decreased in patients in group SHE-L after three months of treatment with lactulose (2.9 ± 0.9 vs 0.8 ± 1.2; P = 0.004); however, there was no change in patients in group SHE-NL after three months (3.7 ± 1.5 vs 3.5 ± 1.3; P = NS). While SHE improved in 8 of 10 patients in group SHE-L, none of the patients in group SHE-NL improved after three months of follow-up (P < 0.001). Two patients in group SHE-NL also developed overt encephalopathy during the study period. We conclude that lactulose treatment in cirrhotic patients with SHE is effective.
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REFERENCES
Gitlin N: Subclinical portal systemic encephalopathy. Am J Gastroenterol 82:8–11, 1988
Quero JC, Schalm SW: Subclinical hepatic encephalopathy. Semin Liv Dis 16:321–328, 1996
Schomerus M, Hamster W, Blunck H, Reinhard U, Mayer K, Doll W: Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci 26:622–630, 1981
Tarter RE, Hegedus AM, van Thiel DM, Schade RR, Gavaler JS, Starzl TE: Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421–1427, 1984
McClain CJ, Potter TJ, Kromhout JP, Zieve L: The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without overt hepatic encephalopathy. J Clin Gastroenterol 6:325–328, 1984
Morgan MY, Alonso M, Stanger LC: Lactitol and lactulose for the treatment of subclinical hepatic encephalopathy in cirrhotic patients. J Hepatol 8:208–217, 1989
Salerno F, Moser P, Maggi A, Vitaliani G, Benetti G: Effects of long term administration of low dose lactitol in patients with cirrhosis but without overt encephalopathy. J Hepatol 21:1092–1096, 1994
De Bruijn KM, Blendis LM, Zilm DH, Carlen PL, Anderson GH: Effect of dietary protein manipulation in subclinical portal-systemic encephalopathy. Gut 24:53–60, 1983
Egberts EH, Schomerus H, Hamster W, Jurgens P: Branched chain amino acids in the treatment of latent portosystemic encephalopathy. Gastroenterology 88:887–895, 1985
Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL: Comparison of lactulose and neomycin in the treatment of chronic portal systemic encephalopathy. A double blind controlled trial. Gastroenterology 72:573–583, 1977
Watanabe A, Sakai T, Sato S, Imai F, Ohto M, Arakawa Y, Toda G, Kobayashi K, Muto Y, Tsujii T, Kawasaki H, Okita K, Tanikawa K, Fujiyama S, Scimada S: Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy. Hepatology 26:1410–1414, 1997
Dhiman RK, Saraswat VA, Verma M, Naik SR: Figure connection test: A universal test for assessment of mental state. J Gastroenterol Hepatol 10:14–23, 1995
Ramalingaswami P: The measurement of intelligence among adult Indians. New Delhi, National Council of Educational Research and Training, 1974
Gitlin N, Lewis DC, Hinkley L: The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulatory, non-shunted patients with cirrhosis. J Hepatol 3:75–82, 1986
Kardel T, Lund Y, Zender Olsen P, Mollgaard V, Gammeltoft A: Encephalopathy and portocaval anastomosis. Scand J Gastroenterol 5:681–685, 1970
Schomerus H, Hamster W, Blunk H, Reinhard U, Mayer K, Doll W: Latent portasystemic encephalopathy I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci 26:622–630, 1981
Quero JC, De Bruiyn I, Hartmann IJC, Schalm SW: Does subclinical hepatic encephalopathy affect quality of life? Gastroenterology 108:A1151, 1995 (abstract)
Das A, Dhiman RK, Saraswat VA, Naik SR: Prevalence and natural history of subclinical porta-systemic encephalopathy in cirrhosis. Gastroenterology 108:A1057, 1995 (abstract)
Rickkers L, Jenko P, Rudman D, Freides D: Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462–469, 1978
Yen CL, Liaw YF: Somatosensory evoked potentials and number connection test in the detection of subclinical hepatic encephalopathy. Hepatogastroenterol 37:332–334, 1990
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Dhiman, R.K., Sawhney, I.M.S., Chawla, Y.K. et al. Efficacy of Lactulose in Cirrhotic Patients with Subclinical Hepatic Encephalopathy. Dig Dis Sci 45, 1549–1552 (2000). https://doi.org/10.1023/A:1005556826152
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DOI: https://doi.org/10.1023/A:1005556826152